scholarly journals Active Management of Third Stage of Labor: A Comparison of Various Uterotonic

2014 ◽  
Vol 6 (3) ◽  
pp. 151-155 ◽  
Author(s):  
Ruchika Goel ◽  
Jai Kishan Goel ◽  
Vineeta Modi ◽  
Anshika Kashyap ◽  
Shashi Bala Arya ◽  
...  

ABSTRACT Aims and objectives This study was aimed at comparing the various uterotonics in active management of third stage of labor and reducing blood loss. Materials and methods A prospective study was conducted in the Department of Obstetrics and Gynecology of SRMSIMS, Bareilly, in 100 women. Patients were randomized into four groups of 25 each and were given oxytocic within 1 minute of delivery of the baby. Oxytocics used were 10 IU intramuscular oxytocin, 0.2 mg intravenous methylergometrine, 125 μg intramuscular 15-methyl PGF2-alpha and 600 μg tablet misoprostol per rectally in groups A, B, C and D respectively. Results Duration of third stage of labor recorded was minimum with methergine with mean duration of 3.84 ± 0.99 minutes and was maximum with prostodin with mean duration of 5.04 ± 1.02 minutes. Amount of blood loss observed was minimum with methergine (mean 131 ± 72.037 ml) and maximum with Prostodin (mean 435 ± 147.578 ml). Hemoglobin drop was also seen maximally with prostodin with mean drop of 0.872 ± 0.458 gm% and minimally with methergine with mean drop of 0.236 ± 0.221 gm%. Change in the general condition of the patients in the form of tachycardia, fall in systolic and diastolic blood pressure was observed maximum with prostodin group whereas, in other groups, there was no significant change. Conclusion It is concluded from this study that methergine is the uterotonic of choice followed by oxytocin for active management of third stage of labor. How to cite this article Modi V, Goel JK, Kashyap A, Arya SB, Kar J, Goel R. Active Management of Third Stage of Labor: A Comparison of Various Uterotonic. J South Asian Feder Obst Gynae 2014;6(3):151-155.

1970 ◽  
Vol 1 (2) ◽  
pp. 25-27
Author(s):  
Meena Thapa ◽  
Rachana Saha ◽  
Sumita Pradhan ◽  
Sushil Thakur ◽  
Archan Shamsher Rana

Objective: Overall objective of the study was to see effects of active management of third stage of labour (AMSTL) with oxytocin. Specific objective of the study was to look for incidence of Post-Partum Haemorrhage (PPH), length of 3rd stage, incidence of retained placenta and average blood loss. Methodology: A hospital based prospective, descriptive, observational study was carried out from 1st July 2005 to 30th June 2006 at department of Obstetrics and Gynaecology, Kathmandu Medical College Teaching Hospital (KMCTH). All patients undergoing vaginal delivery excluding twins, polyhydraminios and instrumental deliveries were included in the study. The active management of 3rd stage included administration of 10 units IU of oxytocin, early cord clamping, controlled cord traction and uterine massage. Blood loss was estimated by visual inspection and measured by jar pressed against perineum. Result: Total number of deliveries during the study period was 530. There were 13 cases of PPH. Incidence of PPH was 2.4%. There were six cases each of uterine atony and genital tract trauma. One case was of retained placenta requiring Manual Removal (MRP). Average third stage duration was less than 5 minutes. Average blood loss was 90 ml. In 2 cases the third stage lasted more than 30 mins. Conclusion: Active management of 3rd stage of labour reduces the incidence of PPH from uterine atony, reduces the duration as well as average blood loss during third stage.condition. Key words: Labor analgesia; epidural, combined spinal epidural; complications, dural puncture, postdural puncture headache (PDPH); prevention.   doi:10.3126/njog.v1i2.1490 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 25 - 27 Nov-Dec 2006


Author(s):  
K. Sharmila

Postpartum haemorrhage (PPH) has been more common over the last three decades, accounting for 11% of all pregnancy-related deaths in the United States. In the third stage of labour, risk classification and active management are crucial preventative techniques. To avoid negative effects, a multidisciplinary approach to PPH patient care is required. To treat uterine atony, uterotonic medicines like oxytocin are used in combination with manipulative procedures like uterine massage and balloon tamponade. The amount of blood loss, duration of the third stage, need for MRP, incidence of PPH, need for repeated oxytocics, and its side effects were measured in Group I 100 women who were administered injection oxytocin 10 IU injection methergin 0.2 mg IV within one minute of the baby's delivery. The mean blood loss at vaginal delivery in Group I was 100-150 ml and in group I P value 0.027, which was statistically significant .In  Group II was 160-200 ml with P value 0.036, which was statistically significant. The mean duration of third stag labour in Group 1 was 124.6 min and Group 2 was 144.8 min intravenous methergin is a better uterotonic when compared to intramuscular oxytocin to reduce the amount of blood loss at delivery and prevent complications like atonic PPH.


Author(s):  
Paridhi Jain ◽  
Nisha Thakur ◽  
Ashu Jain ◽  
Sunita Agarwal ◽  
Sangeeta Kamra ◽  
...  

Background: The present study was done to assess the blood loss during delivery even after active management of third stage of labor with oxytocin and the maternal outcomes of PPH.Methods: We studied 100 pregnant women were either in spontaneous labor or admitted for induction of labor, underwent vaginal delivery or caesarean section in our institute. Active management of third stage of labor in all 100 cases included 10 IU intramuscular oxytocin or 10 to 20 IU intravenous in 500 ml of Ringer’s Lactate. Blood loss in all cases was noted.Results: Of the included cases, 27 had to be given extra-uterotonics for atonic uterus, of which 12 parturient still had PPH. Atonic uterus was the cause of PPH in 11 of the 12 cases, while one case was of atonic uterus plus trauma. Half of all PPH cases responded to medical management alone, five cases had to undergo tamponade/stepwise devascularization and one case had to undergo obstetric hysterectomy. Blood loss was significantly higher in women aged more than 35 years, primigravida, not in labor, oligohydramnios or post-datism, elective LSCS, scarred uterus in and had more than 1 high risk factor. Among various high-risk conditions, significantly higher blood loss was observed in patients with chronic hypertension, gestational hypertension, pre-gestational diabetes mellitus, multipara with prior PPH, placenta previa, preeclampsia and sickle cell trait.Conclusions: Fifteen women avoided PPH by using a reliable method of blood loss measurement and initiating interventions early. Organized PPH management protocol morbidity and mortality of the mother and neonate can be prevented.


Author(s):  
Abubaker Y. H. Abdel Rahim ◽  
Mohamed A. A. Gadir E. Ounsa ◽  
Rayan G. Albarakati ◽  
Elsadig Y. Mohamed ◽  
Sawsan M. Abdalla

Background: The aim of the present study was to compare the effectiveness of sublingual misoprostol, intravenous infusion of oxytocin, and intravenous infusion of Ergometrine in reducing blood loss during the third stage of labor.Methods: This is a no-random trial study conducted in in Ribat University Hospital, Khartoum among 150 laboring ladies with a healthy singleton pregnancy. After obtaining their written informed consent to participate in the study, they were randomly assigned to one of three possible treatment groups: 400 μg of sublingual misoprostol; 10 IU of intravenous infusion oxytocin; and 0.5 mg of intravenous infusion of Ergometrine. Blood loss was estimated by weighing the collected blood and converting the weight to milliliters.Results: The shortest mean duration of the third stage of labor was seen in patients who received misoprostol (3.89±0.37 min), followed by oxytocin (4.6±0.9 min), and Ergometrine (5.45±0.9 min). The lowest mean blood loss was seen in the patients who received 400 µg misoprostol (168.36±24.83 ml), followed by those who received 10 IU oxytocin (205.56±34.82 ml), and 0.5 mg Ergometrine (214.49±35.97 ml).Conclusions: Present study showed that 400 µg sublingual misoprostol was more effective than the conventional parenteral uterotonics in reducing the amount of the blood loss during the third stage of labor and has comparable effect to that of 10 IU intravenous oxytocin in shortening the duration of third stage of labor. It also showed that the use of misoprostol reduces the need for extra-uterotonics and blood transfusion.


2018 ◽  
Vol 6 (1) ◽  
pp. 19-21
Author(s):  
Nilam Subedi ◽  
Deepanjali Sharma ◽  
Rubby Das

Introduction: Postpartum Haemorrhage (PPH) is one of the leading causes of maternal mortality worldwide. A simple measure to prevent PPH is active management of third stage of labour (AMTSL). This prospective study was conducted in Universal College of Medical Sciences and Teaching Hospital, Tribhuvan University,  Bhairahawa where misoprostol  600  mcg  orally was compared with the standard  oxytocin regime in active management of third stage of labour.Materials and Methods: A total of 100 women were selected to receive either 600 mcg misoprostol orally or 10 IU oxytocin intramuscularly. The incidences of postpartum hemorrhage and side effects were examined.Results: Both groups were comparable in age, parity, gestational age, pre-delivery hemoglobin, and duration of labor. There was no significant differences between the misoprostol and oxytocin groups in terms of blood loss  96% vs 100% had blood loss of < 500 ml, p=0.475). And incidence of PPH  (4% vs 0%). None of the group had severe PPH i.e. blood loss> 1000 ml. The duration of the third stage of labor, a secondary outcome measure was shorter in the misoprostol group than in the oxytocin group (7.02±2.26 SD vs 8.44±4.08 SD, p=0.034). Two women of oxytocin group received a blood transfusion. The adverse effects of shivering and pyrexia were encountered more frequently in the misoprostol than in the oxytocin group (2% vs 38%, p<0.001, P<0.001; and 2% vs 10%, p=0.207). No major surgical intervention for atonic PPH was needed and no maternal deaths occurred in either group.Conclusion: Misoprostol 600 mcg orally is equally as effective as standard oxytocin regime in AMTSL to prevent PPH and can be safely used in the peripheral institutions or by midwives where there is lack of trained personnel and storage facility.Journal of Universal College of Medical SciencesVol. 6, No. 1, 2018, Page: 19-21


Author(s):  
Neetu Verma ◽  
Monica Soni ◽  
Priyanka Singh

Background: The aim of the study was to determine effect of intra-umbilical oxytocin along with active management on duration and amount of blood loss in 3rd of stage of labor.Methods: This was a hospital based prospective, randomized, case-control study conducted in the department of OBG between 1st September 2019 to 31st December 2020. After obtaining permission from ethical committee, screening of inclusion and exclusion criteria and informed consent of participants, 300 cases were enrolled. In group A (control) 20 ml normal saline and in group B (case) 20 IU oxytocin diluted in normal saline to make a 20 ml solution was given intra-umbilically along with standard active management of third stage labor. The data was systematically recorded and analysed.Results: Both the groups were comparable in terms of demographic data.  A statistically significant reduction in the duration of third stage of  labor (1.83±0.64  min in group B vs 2.92±0.79 min in group A), amount of blood loss (203.73±62.11 ml in group B vs 328.83±87.18 ml  group A) and fall in haemoglobin (9.28±1.03 g/dl in the study group A vs 9.97±1.28 g/dl in group B) and haematocrit (31.20±3.05% in  study group A vs 33.60±3.31%  in study group B)  were noted, taking p value  significant <0.05.Conclusions: Intra-umbilical oxytocin was associated with a significant reduction in duration and amount blood loss in third stage of labor.


Author(s):  
Sabitha Umapathy Srinivasan ◽  
Swarnamukhi P.

Background: Postpartum haemorrhage (PPH) is the leading cause of maternal death globally. The routine practice of active management of third stage of labour has been shown to reduce haemorrhage by up to 60%. The present study evaluated the role of methylergometrine versus oxytocin in active management of third stage of labour in reducing the risk of PPH.Methods: This study was conducted on a total of 400 women admitted in the labour ward of PESIMSR hospital, by using simple randomized design. The first study group included women who received intramuscular oxytocin (n=200) and, the second group included women who received intravenous Methylergometrine (n=200) within, one minute of delivery of the baby.Results: The mean blood loss among study first and the second study group were 172.8 ml and 148.9 ml respectively (p<0.05) and, the mean duration of third stage of labour were 5.9 and 5.1 minutes respectively (p<0.05). The mean pre-and post-delivery haemoglobin values among the first and second group were 11.76 mg/dl, 10.46 mg/dl and, 11.76 mg/dl, 10.6 mg/dl respectively (p<0.05). There was an increase in the blood pressure in the ergometrine group and, slight decrease of blood pressure in oxytocin group.Conclusions: The use of methyl ergometrine as part of active management of third stage of labour was associated with a significant reduction in mean blood loss value, duration of third stage of labour, and the additional need of oxytocic though, methylergometrine has significant side effects like nausea, vomiting and rise in blood pressure.


2009 ◽  
Vol 1 (3) ◽  
pp. 19-23
Author(s):  
Mahmud Ghazala ◽  
Tasnim Nasira ◽  
Fatima Saba

ABSTRACT Objective To determine the efficacy and safety of oral misoprostol with intravenous oxytocin and syntometrine in the active management of third stage of labor. Methodology 325 women were randomly allocated by convenient sampling to receive either 10 IU of intravenous oxytocin or 10 IU of oxytocin with 0.2 mg of Methergine (syntometrine) or 400 mcg of oral misoprostol at the delivery of anterior shoulder. Main outcome measures were estimation of blood loss > 500 ml, drop in hemoglobin/hematocrit levels and adverse effects of drugs. Results Estimated blood loss was significantly higher in group misoprostol group (p = 0.016) but comparable to oxytocin group (p = 0.40). Drop in hemoglobin level was comparable in all the three groups (p = 0.106). Drop in hematocrit value was significant for misoprostol and syntometrine (p = 0.022) but comparable to oxytocin. Nausea and vomiting was common in oxytocin and syntometrine group whereas fever and shivering was the leading adverse effect in misoprostol group. Conclusion Misoprostol is an effective and safe alternative to intravenous uterotonic agents in the active management of third stage of labor both at tertiary and community level.


Author(s):  
Harshita Naidu ◽  
Sujatha B. S. ◽  
Muralidhar V. Pai

Background: Postpartum hemorrhage is the most common preventable cause of maternal mortality in developing countries. The present study aimed to examine the impact of cervical traction technique in reducing the amount of postpartum blood loss and rate of PPH.Methods: This was a case-control, pilot study conducted in a tertiary hospital between June 2017 to June 2018. A total of 200 singletons, low-risk pregnant females, undergoing normal vaginal delivery, were enrolled in this study. Subjects showing a high risk for PPH were excluded. Patients were randomized as case group (n=100) and control group (n=100). The case group received sustained traction for 90 seconds to anterior and posterior lip of the cervix with active management of the third stage of labor, whereas the control group received routine active management of the third stage of labor. All subjects were followed up for 6 hours post-delivery. The amount of blood loss, hematocrit and hemoglobin post-delivery were compared between both groups.Results: The mean blood loss (ml), decrease in hemoglobin (g/L) and decrease in hematocrit post-delivery in cases were significantly low compared to controls (207±37.6 versus 340±49, P<0.01), (0.78±0.2 versus 1.4±0.3, P=0.03) and (1.7±0.2 versus 3.5±0.2, P<0.01). PPH occurred in 7 of 200 (3.5%) patients. The difference in the number of PPH was not significant (5/100; 5% versus 2/100; 2% P=0.2). There were no complications reported due to cervical traction.Conclusions: Cervical traction is a simple and safe maneuver to reduce the amount of postpartum blood loss. Larger RCT is recommended to investigate the reduction in PPH rate.


Author(s):  
Charul Mittal ◽  
Jaya Choudhary ◽  
Akshi Agarwal ◽  
Kalpana Tiwari

Background: WHO defines postpartum haemorrhage (PPH) as when blood loss is greater than or equal to 500 ml within 24 hours after birth. When blood loss is greater than or equal to 1000 ml within 24 hourrs, it is called as severe primary postpartum haemorrhage. Placental blood drainage is done by clamping and cutting of umbilical cord after birth of baby followed by unclamping the maternal side of cord so the blood can drain freely into a container.Methods: 200 patients were studied in current research finding. Study group had 100 patients whose placental blood drainage was done and control group had 100 patients whose placental blood drainage was not done. This study was done to analyze the effectiveness of placental blood drainage in reducing blood loss.Results: The duration of third stage of labor was 295.70 seconds in study group and 475.20 seconds in control group. The amount of blood loss in study group was 273.76 ml and 294.92 ml in control group. p value was found to be significant. Incidence of PPH in study group was 1% and 8% in control group.Conclusions: Placenta blood drainage was safe and simple. It is a non invasive method very useful to prevent PPH. It reduces the duration of third stage of labor and reduces amount of blood loss.


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